Health Equity and Accountability Act of 2020 Is Critically Needed to Address Health Disparities, Including Those Caused By Tobacco

WASHINGTON, D.C. – The Campaign for Tobacco-Free Kids applauds Rep. Jesus “Chuy” Garcia (D-IL) and the Congressional Tri-Caucus for introducing the Health Equity and Accountability Act of 2020, which provides a comprehensive strategy for addressing health disparities in the United States, including disparities caused by tobacco use. Among other things, this legislation would significantly increase tobacco taxes and expand coverage for tobacco cessation services under Medicaid and private health plans, which are proven strategies to reduce tobacco use and the death and disease it causes.

This legislation could not be more timely as the COVID-19 pandemic is disproportionately harming communities of color and exposing longstanding health disparities that must be addressed with urgent national action. Smoking is a major cause of underlying health conditions that increase risk of severe complications from COVID-19 and disproportionately impact communities of color, including heart disease, lung disease and diabetes. This legislation also comes as health experts warn that smoking and vaping can worsen the effects of COVID-19.

While the U.S. has made enormous progress in reducing smoking, there are large disparities in who still smokes and who suffers from tobacco-related diseases and death. Smoking rates are highest among people with lower income and less education, those who are uninsured or on Medicaid, American Indians/Alaska Natives, residents of the Midwest and South, LGBT Americans, and people with mental illness. In addition, the tobacco industry’s long history of targeting African Americans with marketing for menthol cigarettes – and resulting high rates of menthol smoking among African Americans – has had a devastating impact. The evidence is clear that menthol makes it easier for kids to start smoking and harder for smokers to quit. African Americans quit smoking at lower rates and suffer high rates of tobacco-related diseases, including lung cancer, heart disease, stroke, COPD and diabetes.

The Health Equity and Accountability Act (HEAA) of 2020 requires comprehensive tobacco cessation coverage for all Medicaid beneficiaries without cost sharing or preauthorization. These services include individual, group and telephone counseling, as well as seven FDA-approved medications. While states have made progress in providing cessation coverage under Medicaid, only 15 states currently cover all available treatments and only two states cover all treatments without any barriers to access.

Comprehensive Medicaid coverage of tobacco cessation services is critical as Medicaid beneficiaries smoke at twice the rate of those with private insurance. It is also cost-effective as Medicaid spends more than $40 billion a year on health care for smoking-related diseases. Importantly, the bill provides needed funding to allow states to conduct outreach campaigns to educate Medicaid beneficiaries about the program.

After Massachusetts provided comprehensive Medicaid coverage of smoking cessation services in 2006 and conducted an outreach campaign to raise awareness of the benefit, the smoking rate among beneficiaries declined by 26 percent in the first 2.5 years. The state dramatically reduced hospitalizations for heart attacks and cardiovascular disease among Medicaid recipients, saving more than $3 for every $1 spent on cessation services, studies have shown.

In addition, the bill doubles the cigarette excise tax and creates tax parity for other tobacco products. Raising the price of tobacco products is one of the most effective ways to reduce tobacco use, especially among price-sensitive kids.

We applaud Rep. Garcia and his colleagues for their leadership in tackling the enormous problem of health disparities at this critical time, including disparities caused by tobacco use. This legislation will improve health and save lives among the most vulnerable Americans.

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